Provider Demographics
NPI:1083626030
Name:GWALTNEY, STEVE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:A
Last Name:GWALTNEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 PRUDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4206
Mailing Address - Country:US
Mailing Address - Phone:757-539-3021
Mailing Address - Fax:757-539-6262
Practice Address - Street 1:2486 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4206
Practice Address - Country:US
Practice Address - Phone:757-539-3021
Practice Address - Fax:757-539-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice